Unusual Uveitic CME Amir Hadayer, MD Ophthalmology & Visual Sciences University of Louisville School of Medicine January 2016 1

Presentation CC: Blurry vision OU for 6 MO HPI: 23 yo WF Blurry vision, photophobia and floaters OU for 6 MO Denies ocular pain, red eye or irritation h/o ant. granulomatous uveitis + CME OU Partial response to PO steroids, periocular Kenalog OU and PF OU Off Tx currently

History POHx: none PMHx: occasional cold sores Meds: OCP Allergies: PCN

Ophthalmic Exam RAPD – neg 20/30 BCVA -1.25 M -1.50 Full VF Intact EOM 5 mm irregular Pupils 15 IOP 11 RAPD – neg

Ophthalmic Exam Intact L/L Quiet Conjunctiva Mild endothelial dusting, no KP’s Cornea Deep, +0.5 cells, +1 flare A/C PS Iris Clear, pigment on capsule Lens +2 cells Vitreous Normal disc, CME. Vessels and periphery WNL Fundus

OD OS

0:54 4:49

0:20 0:34 5:23

Assessment / Plan 23 yo WF presenting with chronic granulomatous panuveitis (MFC) + CME OU with partial response to treatment Plan: Lab evaluation 40 mg prednisone PO

Results Cr, BUN: WNL ALT, AST, GGT, Bili T, Bili D: WNL WBC, Hb, PLT: WNL UA: m/p contamination HSV IgM I/II combination: positive CMV IgM: negative EBV IgM: negative, IgG: positive Varicella IgM: negative, IgG: positive RPR: negative Quantiferron: indetermined

MCP Bilateral Young myopic women Small multiple yellowish choroidal lesions of the posterior pole Evolve to punctate choroidal scars

Highlights IGRA can also react with atypical mycobacteria Case report: 66 yoM with recalcitrant CME s/p cataract + ERM peeling OS 4 x subtenon Kenalog injections failed ICG: numerous choroidal hypofluorescent dots and fuzzy vessels OU Quantiferron: positive, constitutional symptoms positive, CXR opacity Bronchial aspirate positive for M. Kansasii Following triple therapy uveitis subsided, CME resolved and BCVA improved.

References Kuznetcova TI, Sauty A, Herbort CP. Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity). Int Ophthalmol. 2012;32(5):499-506 BSCS 9 Intraocular inflammation and uveitis

Thank you